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8 LONG TITLE
9 General Description:
10 This bill requires the state Medicaid program and Public Employees' Benefit and
11 Insurance Program to cover exome sequence testing.
12 Highlighted Provisions:
13 This bill:
14 ▸ defines terms; and
15 ▸ requires the state Medicaid program and Public Employees' Benefit and Insurance
16 Program to cover exome sequence testing for certain enrollees.
17 Money Appropriated in this Bill:
18 None
19 Other Special Clauses:
20 None
21 Utah Code Sections Affected:
22 ENACTS:
23 26-18-25, Utah Code Annotated 1953
24 49-20-419, Utah Code Annotated 1953
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26 Be it enacted by the Legislature of the state of Utah:
27 Section 1. Section 26-18-25 is enacted to read:
28 26-18-25. Coverage of exome sequence testing.
29 (1) As used in this section, "exome sequence testing" means a genomic technique for
30 sequencing the genome of an individual for diagnostic purposes.
31 (2) The Medicaid program shall reimburse for exome sequence testing:
32 (a) for an enrollee who:
33 (i) is younger than 21 years of age; and
34 (ii) who remains undiagnosed after exhausting all other appropriate diagnostic-related
35 tests;
36 (b) performed by a nationally recognized provider with significant experience in exome
37 sequence testing;
38 (c) that is medically necessary; and
39 (d) at a rate set by the Medicaid program.
40 Section 2. Section 49-20-419 is enacted to read:
41 49-20-419. Coverage of exome sequence testing.
42 (1) As used in this section, "exome sequence testing" means a genomic technique for
43 sequencing the genome of an individual for diagnostic purposes.
44 (2) Beginning July 1, 2019, the program shall provide coverage for exome sequence
45 testing:
46 (a) for a covered individual within the state risk pool who:
47 (i) is younger than 21 years of age; and
48 (ii) who remains undiagnosed after exhausting all other appropriate diagnostic-related
49 tests;
50 (b) performed by a nationally recognized provider with significant experience in exome
51 sequence testing;
52 (c) that is medically necessary; and
53 (d) at a rate set by the program.